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Coronaviruses (CoV) make up a large family of viruses, known since the mid-1960s, which received this name due to the spikes on its surface, which resemble a crown (from the Latin corona). CoV infections can cause everything from a common cold to severe respiratory syndromes, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). COVID-19 is a new variant of the coronavirus, and its isolation occurred in China on January 7th, 2020. COVID-19 has stood out with a high impact on public health due to the high number of cases with infection in a short period of time. However, it is possible to observe that 17% of patients confirmed with COVID-19 have severe infections and about 2.5% of these patients die. Current studies have shown that the number of mild and asymptomatic cases may be even greater. Thus, the challenges for controlling unreported cases of patients with mild symptoms that are spreading the virus and interfering with the magnitude and real data of the cases stand out. The transmission of the coronavirus occurs between humans, and it can occur from person to person through the air, through coughing or sneezing, by touching or shaking hands or by contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes. Given the fluctuation in the incidence and the lethality rate, it is essential to stand out the precepts of health promotion in search of reorienting hygiene practices, considering that there is validity in health care models, still with a curative approach and the current situation experienced by the world population requires a preventive stance.

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

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BackgroundWe evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers.MethodsCross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W), height (H) and body mass index (BMI) were classified according to the 2000 National Center for Health Statistics (CDC/NCHS). Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center.ResultsChildren presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively.ConclusionLow income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.

Our findings demonstrated that the results obtained for ampicillin may accurately predict the in vitro susceptibility to amoxicillin but not to imipenem and piperacillin among isolates of Enterococcus faecalis resistant to penicillin but susceptible to ampicillin, which have emerged recently, in contrast to penicillin-and ampicillin-susceptible isolates. Enterococci are intrinsically resistant to several antimicrobial classes and show a great ability to acquire new mechanisms of resistance. Resistance to ␤-lactam antibiotics is a great concern because these drugs are commonly used for treatment of enterococcal infections, alone or associated with aminoglycosides, since such combination therapy results in the synergistic killing of the enterococci (5). ␤-Lactamase production, overproduction of lowaffinity penicillin-binding proteins (PBPs), and occurrence of point mutations in PBPs, especially PBP5, are the mechanisms of ␤-lactam resistance that have been reported in enterococci (5,12).Although all enterococci are intrinsically resistant to cephalosporins, Enterococcus faecalis remains usually susceptible to the other ␤-lactam antibiotics, including the carbapenems, in contrast to Enterococcus faecium. Furthermore, until recently, it was assumed that E. faecalis strains exhibiting susceptibility to ampicillin were also susceptible to penicillin; however, the emergence of isolates resistant to penicillin but susceptible to ampicillin showed that the resistance to both ␤-lactams may not be linked in enterococci (6,8). Currently, according to the Clinical and Laboratory Standards Institute (CLSI) (3), ampicillin results may be used to predict E. faecalis susceptibility to amoxicillin, imipenem, and piperacillin among non-␤-lactamase-producing E. faecalis strains, while isolates susceptible to ampicillin cannot be assumed to be susceptible to penicillin. Therefore, as there are few published studies about penicillin-resistant, ampicillin-susceptible E. faecalis strains, we propose here to evaluate whether the susceptibility to ampicillin can really predict the susceptibility to amoxicillin, imipenem, and piperacillin among E. faecalis isolates exhibiting this unusual penicillin resistance phenotype.(This study was presented in part at the 21st European Congress of Clinical Microbiology and Infectious Diseases [ESCMID], Milan, Italy, 7 to 10 May 2011.)A collection of 317 E. faecalis isolates, recovered during a study conducted at a Brazilian hospital in the period of February 2006 to June 2010 (4), was tested for ampicillin and penicillin susceptibility. Thirty-four (10.7%) isolates were penicillin resistant and ampicillin susceptible in the three susceptibility tests performed (Etest, broth dilution, and disk diffusion). The species identification of all selected isolates was performed based on phenotypic tests (9) and confirmed by PCR using specific primers described elsewhere (4). These isolates were recovered from wounds (35.3%), urine (32.4%), secretions (14.7%), blood (11.8%), and catheter tip (5.9%). They showe...

Introduction: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. Methods: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). Results: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87% were E. faecalis and 10.8% E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5% to 15.5% (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256μg/ mL) and harbored vanA genes. The majority (89.5%) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5% to 21.4% from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. Conclusions: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.

A caracterização das hemorragias periventriculares-intraventriculares (HPIV) no período neonatal em recém-nascidos pré-termo constitui um evento importante para a prevenção de seqüelas em curto e longo prazo. Foi objetivo deste estudo avaliar a freqüência da hemorragia peri-intraventricular (HPIV) em recém-nascidos pré-termo e correlacioná-la com o peso ao nascer, num estudo observacional e transversal realizado em uma unidade de terapia intensiva neonatal, do Hospital do Servidor Público Estadual (HSPE), na cidade de São Paulo no período de janeiro de 1996 a dezembro de 1997. Foram incluídos no estudo 70 de 102 recém-nascidos com peso menor de 2000g, sendo utilizada a classificação de Papille, que classifica HPIV em quatro graus, conforme a extensão da mesma. As ecografias foram realizadas nos 4º, 8º, 15º e 28º dias de vida, desde que os recém-nascidos permanecessem internados na unidade de cuidados intensivos do HSPE. Foram diagnosticados 32 casos de HPIV. Houve correlação estatisticamente significante (pd"0,001) do peso com a ocorrência da HPIV, sendo que o grupo acometido foi o que apresentou menor média de peso. Assim, a HPIV é um evento freqüente em recém-nascidos pré-termo e está relacionada com peso ao nascer inferior a 1500g. O exame ultra-sonográfico mostrou-se eficaz no diagnóstico, devendo a partir do diagnóstico da HPIV, haver o encaminhamento do recém-nascido para ao acompanhamento ambulatorial com equipe multidisciplinar.